Personality disorders are persistent but can still wax and wane in severity due to life circumstances, phases of life, social support, and various stressors. For many people with personality disorders, they are often not aware of their personality traits. If they are aware, they may not view them as a problem. About half of people who meet the criteria for a personality disorder will also meet the requirements for at least one other personality disorder. People with personality disorders are more likely to have comorbid diagnoses, including mood and anxiety disorders, eating disorders, and substance use disorders. The development of personality disorders has genetic and environmental components, like stressors and trauma.
There are three clusters of personality disorders: cluster A (paranoid, schizoid, schizotypal), cluster B (histrionic, narcissistic, borderline, antisocial), and cluster C. Cluster C disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Cluster C is also known as the anxious and fearful cluster. The personality disorders in cluster C are often regarded as the least severe of the personality disorders (along with histrionic personality disorder). Individuals are more likely to seek treatment and have a good prognosis.
Individuals with avoidant personality disorder are often fearful of other people and fearful of criticism. This personality disorder has the second highest level of functioning. About 2% of the population is affected, equally in both sexes. Individuals often show signs starting in childhood with shyness, isolation, and a fear of strangers and new situations. This shyness tends to worsen into adolescence and adulthood. Of course, not everyone shy will have this personality disorder.
In addition to appearing timid and anxious, individuals with avoidant personality disorder often experience feelings of inadequacy and loneliness. They may find it difficult to talk about themselves and have low self-esteem with sensitivity to criticism. Though they are frequently uncomfortable in social and intimate settings, they typically desire to deepen their relationships but anticipate ridicule, rejection, or humiliation, which causes them to avoid situations entirely unless there is a guaranteed good outcome (e.g., being liked). This risk aversion leads to further feelings of shame and inferiority. This personality disorder often co-occurs with depression, bipolar disorder, and anxiety disorders (especially social anxiety disorder). Individuals commonly self-medicate with alcohol and benzodiazepines to cope with their feelings. The first line of treatment is psychotherapy, social skills training, and medications for co-occurring anxiety and depression.
Individuals with dependent personality disorder have a fear of losing others and a fear of the inability to take care of themselves. Dependent Personality Disorder is considered the third highest-functioning personality disorder and affects about 0.5% of the population. It is equal in men and women but is diagnosed most in women. Men may not come forward because of the stigma of relying on others, while women are usually more comfortable doing so.
Individuals with dependent personality disorder are often clingy and submissive, with an excessive need for care, which may present as childlike behavior. They often exhibit pessimism, self-doubt, and a lack of self-confidence. These traits come from a fear of separation and a devaluation of their abilities and decision-making skills. Decisions often give them anxiety, so they seek relationships with those who can provide guidance. They may need someone to help decide small choices, like what to have for breakfast, what gas station to stop at, and what choices to make at work, but this can exist on a severity spectrum. They usually start out relying on their parents to help make decisions. Then, this shifts to a significant other in their adult life, so individuals may quickly initiate a new relationship after one ends to fill the role fast. Since they often choose a single person to look to for support and approval, their self-value revolves around another person. They often experience difficulty expressing disagreement since they want to remain in the relationship, so they may make self-sacrifices and even tolerate abuse. With limited ability to stick up for themselves effectively, they are vulnerable to manipulation. The sense of urgency to find someone to help them navigate life has complications on its own, and they may be looking for a partner to fit the role of a parent. Management includes psychotherapy that encourages independence and the treatment of co-occurring anxiety.
I think the term daddy issues is overused and vague. However, I think behavior linked to daddy issues may indicate a pattern of dependent personality disorder. However, this disorder is not present in co-dependent relationships, an unhealthy dynamic that takes two to create. People with dependent personality disorder will have this issue in every relationship. You will not see a couple with individuals with dependent personality disorder because affected individuals need to be with someone who can make decisions and give them a feeling of security. You will not see them together because they will always want to shift power over to the other person. You are more likely to see a person with dependent personality disorder in a relationship with someone with narcissistic personality disorder or someone else that will happily take control of the relationship.
Obsessive-compulsive personality disorder (OCPD) is common, affecting about 7% of the population. We probably know someone with this, especially if you are in the healthcare field. It is considered the highest functioning of all personality disorders and is twice as common in men as in women.
Individuals with OCPD are preoccupied with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. They may find themselves rereading paragraphs because they feel the need to know everything perfectly. Because of this, they could end up not finishing the chapter assigned to read or meet project deadlines. They make great students otherwise but often struggle with team efforts, especially when delegating tasks to others. They are careful and prone to repetition, paying extraordinary attention to detail with repeated checking for possible mistakes.
People with OCPD are often excessively devoted to work at the expense of relationships and leisure activities. When they take time for leisure activities or vacations, they are very uncomfortable unless they have taken along something to work on. Hobbies or recreational activities are serious, requiring careful organization and hard work to master. A day spent with friends and family or doing something fun that is not goal-oriented may be a waste of time. There is an emphasis on perfect performance, and they are highly self-critical about their mistakes. OCPD overlaps with “type A” personality characteristics (e.g., preoccupation with work, competitiveness, time urgency) but has additional features you would not find. People with OCPD have difficulty expressing tender feelings and rarely pay compliments. Individuals with OCPD are prone to becoming upset or angry in situations they cannot lose control of their physical or interpersonal environment, though anger is typically not expressed directly. They appear stiff and emotionally distant. Many individuals function very well professionally, while others have difficulties across different domains of their life (like interpersonal relationships). OCPD is associated with depression, bipolar disorder, and eating disorders. They do not often seek treatment, but psychodynamic psychotherapy is the first-line therapy.
I see some of these characteristics in my life, so I want to state that if you meet some criteria for any of these, it does not mean anything is wrong with you. However, I think that most people (if not everyone) would benefit from therapy regardless of diagnosis.
Obsessive-compulsive personality disorder (OCPD) is what people mean when they say "OCD" in casual language, but obsessive-compulsive disorder is very different than OCPD. OCD involves obsessions (recurrent and persistent thoughts, urges, or images that are intrusive and unwanted) and compulsions (repetitive behaviors or mental acts like handwashing, checking the stove, and ordering objects a certain way) that they must perform in response to an obsession or according to rigid, internal rules.
Psychodynamic therapy is the first-line treatment for most personality disorders. This therapy focuses on helping people become aware of their traits and guiding them to modify their behavior and thought processes while adapting healthier ways of interacting with the world. This therapy is especially effective for histrionic, avoidant, dependent, and obsessive-compulsive personality disorders. Other options for therapy include cognitive behavioral therapy,supportive psychotherapy, and group psychotherapy. Medications cannot cure personality disorders or change any of the pervasive patterns of personality traits but are beneficial to treat co-occurring anxiety and depression to support individuals with personality disorders.
Listen to the related episode on First Line here.